Application of a multi-faceted approach for the assessment of treatment response in falciparum malaria: a study from Malaysian Borneo.

Thirty-two patients reporting to the Lundu District Hospital, Sarawak, Malaysian Borneo, with uncomplicated falciparum malaria were recruited into a multifaceted study to assess treatment response. Following combined chloroquine and sulphadoxine/pyrimethamine treatment the patients were followed for 28 days according to the World Health Organisation in vivo drug response protocol. The in vivo study revealed that 13 (41%) of the patients had a sensitive response to treatment, five (16%) cleared asexual stage parasites but had persistent gametocytes, 11 (34%) had RI type resistance and three (9%) had RII type resistance requiring quinine intervention before day 7 for parasite clearance. Although clinically insignificant, patients with persistent gametocytes, surviving chloroquine and sulphadoxine/pyrimethamine treatment during maturation, were placed in the reduced response to treatment group for analysis. Allelic typing detected 100% prevalence of the pfcrt K76T marker associated with chloroquine resistance and 78% prevalence of the pfdhfr NRNL haplotype associated with sulphadoxine/pyrimethamine treatment failure. High serum chloroquine levels and pfdhfr haplotypes with

Differences in Anopheles composition and malaria transmission in the village settlements and cultivated farming zone in Sarawak, Malaysia.

Anopheles mosquitos were surveyed using three trapping technics in four longhouse settlements and their respectively farming zone in western Sarawak, Malaysia. The study area was mountainous with tropical rain forest. An. leucosphyrus and An. donaldi were predominant in the farm huts. An. tessellatus and An. subpictus were more abundant in the village settlements. In both ecotypes, human baited traps yielded a significantly greater proportion of Anopheles mosquito than CDC light traps and landing biting catches. Circumsporozoite antigen positively rate, mosquito survival rate and parasite rate showed that malaria transmission is more intense in farm huts than in longhouse settlements. The entomological inoculation rate of An. donaldi and An. leucosphyrus in farm huts was 0.035 and 0.023, respectively. No sporozoite infections were observed in the main settlements.